Affordable Care Act Information

The Patient Protection and Affordable Care Act is a federal statute which was signed into law in 2010. It is often referred to as the Affordable Care Act, ACA, “Obamacare” or health care reform.

New Health Coverage Exchange called the Health Insurance Marketplace If you are uninsured, purchase individual coverage or believe your employer provided coverage is inadequate or unaffordable, you may be able to shop for coverage directly in the federal Health Insurance Marketplace -- a new marketplace where you can shop for and compare health benefit plans. Open enrollment for coverage in 2015 is November 15, 2014 through February 15, 2015. Open enrollment for coverage in 2016 is November 1, 2015 through January 31, 2016. For more information, visit: www.healthcare.gov.

Healthy Michigan Plan: Some Michigan residents may be eligible for the Healthy Michigan Plan, a new health coverage program that began on April 1, 2014. To be eligible for the Healthy Michigan plan, you must be:

Ages 19-64

Not currently eligible for Medicaid

Not eligible for or enrolled in Medicare

Not pregnant when applying for the Healthy Michigan Plan

Earning up to 133% of the federal poverty level (The federal poverty level is adjusted annually. In 2014, 133% of the poverty level for an individual was $15,521 or $31,721 for a family of four)

Financial Help to Purchase Health Care Coverage Federal tax credits to assist with the cost of health coverage in the Health Insurance Marketplace may be available for those with income between 100 percent and 400 percent of the federal poverty level who are not eligible for other affordable coverage. (The federal poverty level is adjusted annually. In 2014, 400 percent of the poverty level for Michigan residents was about $46,680 for an individual or $95,400 for a family of four.) To apply for the tax credit, visit the Health Insurance Marketplace: www.healthcare.gov.

Health Coverage RequirementThe “individual mandate” provision of the Patient Protection and Affordable Care Act (ACA) requires that people obtain health insurance or pay a federal tax penalty. If you currently have coverage from Medicare, Medicaid or an employer, you are considered covered and will not pay a tax penalty.

Those who do not have or do not obtain coverage will pay a tax penalty. The amount of the penalty for an individual is phasing in as follows:

Essential Health Benefits The ACA ensures that new health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following ten categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

No Denial for People with an Illness or Chronic ConditionNo insurance company can turn you down, charge you more or impose a waiting period for coverage because you have a pre-existing medical condition.

No-Cost Preventive Care New health plans must eliminate any cost-sharing for certain preventive services. Health carriers cannot charge a deductible, copay, or coinsurance for preventive care measures such as flu shots and other immunizations, mammograms and other cancer screenings, diabetes screenings and more.

Ban on Health Policy Rescissions Health carriers are prohibited from rescinding or retroactively canceling your health coverage unless you committed fraud or made an intentional misrepresentation of an important fact on your application.

No Lifetime Limits on Your Health Care Costs For new plans, health carriers will be prohibited from setting lifetime limits on significant benefits, such as hospitalization and emergency services.

Extended Coverage for Young Adults Most health carriers and employers providing dependent coverage to children are required to make coverage available to adult children up to age 26. This applies to adult children who do not have access to coverage from their own job and regardless of whether or not they are students, financially dependent on their parents, live with their parents or are married.

Medicare Prescription Drug Discounts Seniors who are in the Medicare prescription drug coverage gap known as the “donut hole” will receive discounts on covered prescription drugs and the donut hole will be phased out by 2020.

Help for Small Business Some small businesses may qualify for a small business tax credit to help offset the costs of providing health insurance for employees. To be eligible for the credit, the small must purchase coverage in the SHOP Marketplace. Small businesses may wish to contact an agent or carrier to assist with purchasing coverage from the SHOP Marketplace or visit www.healthcare.gov/small-businesses.

Other Helpful Resources: For more information on the Affordable Care Act, visit: www.healthcare.gov.

Disclaimer - The information provided is only intended to be general summary information for the public. It is not intended to take the place of either the written law or regulations. If you have questions about whether a provision applies to your plan, contact your health carrier, plan administrator, employer or the Department of Insurance and Financial Services - HICAP (DIFS-HICAP@michigan.gov).